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A study was conducted examining patterns of injury in construction workers in rural areas. Data on injuries to construction workers were obtained from emergency room reports from nine emergency rooms in contiguous, rural counties in northwest Iowa. About half of all of the injuries treated in construction workers between September, 1993 and August, 1994 were work related compared with 38.7% for all employed men and 23.9% for all employed women. The combined injury rate for male and female construction workers was 2.7 times that for all employed people and the work related injury rate was 4.6 times that of all employed people. Nearly half of the construction injury visits were by those under 30 years of age. Construction occupations had approximately a 10% greater proportion of injuries that was work related compared with other occupations. In addition, construction workers had a higher proportion of burn injuries, injuries involving a ladder or scaffold, and injuries caused by crushing, cutting, and piercing. These workers had a lower incidence of transportation related injuries.